Canadian Doctors Hold Lotteries to Decide Who Gets Access to Care

Posted by Peter Nelson in Health Care, Single-Payer Follies on Aug 7th, 2008 | no responses

The National Post reports on how some Canadian doctors have held lotteries to determine which patients to eliminate from their practices, while other doctors held lotteries to decide who they’ll accept. By shedding some patients doctors hope to avoid imposing a 5-minute appointment assembly line on the rest of their patients. Similarly, restricting new patients through a lottery keeps patient loads manageable.

Both lotteries reflect the severe shortage of primary doctors in Canada – yet another example of medical personnel shortages (and surpluses) that tend to crop up under nationalized single-payer health care systems. (Last year it was a nurse shortage and hospital consultant glut in the U.K.)

After being kicked out of her doctor’s practice, one patient was forced to drive 18 kilometers to the next town to find a doctor.

However, an 18 kilometer drive is better than no doctor at all. According to the article, "A paucity of medical professionals has left an estimated five million Canadians without a family doctor." The Canadian Medical Association sponsored website, MoreDoctors.ca, similarly estimates between 4 and 5 million Canadians lack a family physician. Canada’s population numbers about 33 million, meaning a little over 15 percent of Canadians go without primary care. Interestingly, about 15.9 percent of Americans are uninsured. Which is worse, no access or no insurance?

Center of the American Experiment will soon publish the transcript of an interview with Lee Kurisko, a local Minneapolis doctor who once practiced in Thunder Bay, Canada. As a teaser, here’s what he had to say about Canada’s staffing shortages when I posed the following question:

Peter Nelson: You worked in Thunder Bay, which is a decent-sized city, but it’s isolated. Winnipeg, the closest large Canadian city, is pretty far away. When you left Thunder Bay, how easy or difficult was it for the Canadian system to adjust to the fact that you had left?

Lee Kurisko: The entire Canadian system is quite fragile. To a large degree, it’s understaffed. We had serious manpower shortages in Canada when I left. We had only three radiologists providing services to 250,000 people; the Ministry of Health had determined that for us to be adequately staffed, we would need 13, so my resignation was very significant.

I think there’s a lot of fragility because the Canadian system is purposely planned to be based on shortages. About 20 years ago, there was a conscious government decision—this is no secret—to create a rate-limiting step in the delivery of health care in Canada because health care inflation was out of control. The government determined that one way to control health care inflation was to reduce the number doctors they trained, so they started training fewer doctors. At the same time, there were good cures and good treatments for heart disease and cancer developing, so people were being kept alive longer with their conditions. The bottom line is that there was actually an increase in the need for doctors, and there was a conscious effort to cut the number of doctors. Thus, a single doctor leaving became very significant.